Designed to enlighten and amaze.
Can you get the right answer?
You have an otherwise healthy patient living at home that simply won’t come in for their annual visit. Which of the following is appropriate to get that annual visit done?
A. Do a house call.
B. Offer to pay their co-pay.
C. Offer to pay for their transportation.
D. Call them daily until they come in.
E. Inform them that due to the nature of the insurance they’ve chosen, they will be asked to find another PCP if they don’t come in.
The shocking answer below
The answer is E—firing them from your practice.
House calls can only be performed if a patient cannot leave their residence without significant discomfort or difficulty due to their chronic medical problems and it is never appropriate to offer a patient something of value in exchange for providing them services—even services for which the PCP is not directly paid. And of course, you should never harass a patient (though, unfortunately, some practices do).
As a last resort, though, a PCP can report a non-compliant patient to their insurer and ask them to be removed from their panel. This should not be commonly done but it is a legitimate option.
I’ve never had to do this myself, a discussion over the phone with the patient regarding the nature of the insurance have chosen usually suffices. I always had two or three patients that would never come in, but since I was the only doctor around, I felt it was my responsibility to continue having them on my panel.
If there are no other options and you’re hard pressed, firing a patient is always an option. Medicare Advantage is a two-way street—the patient gets more benefits compared to Traditional Medicare, but must engage with their PCP in exchange.
With that in mind, don’t feel bad about discharging a patient who doesn’t engage.
They’re trying to get something for nothing.